Course Information Form

SCE notification of course.

Individual Completing form Individual Completing form * First Last
Email of individual completing form. *
Department Chair
Department Chair Email *
Dean of College
Dean of College Email *
Type of Course *

Type of Course Online Course Online - Contracted Credit/Sponsored Credit Special Topics Course Off Campus Course Contracted Credit/Sponsored Credit
Sponsoring Agency
Faculty is approved to teach online?

Faculty is approved to teach online? Yes Working on it No
Will a fleet vehicle be needed for off campus teaching?

Will a fleet vehicle be needed for off campus teaching? Yes No
Term *

Term Fall Spring Summer
Subject *
Course Number *
Course Title
Student Credit Hours
Faculty Workload
Instructional Delivery *

Instructional Delivery Lecture (face to face) Lab Lab/Lecture Combined Internet Hybrid (internet and face to face)
Enrollment Cap *
Waitlist?

Waitlist? Yes No
Number of students that can waitlist?
Restricted to off campus students? *

Restricted to off campus students? Yes No
Course Start Date Course Start Date * / MM / DD YYYY
Course End Date Course End Date * / MM / DD YYYY
Class meeting dates (face to face) [put N/A if not needed] *
Meeting times (face to face)[put N/A if not needed] *
Class meeting location (face to face) [put N/A if not needed] If you have a preferred room, please provide the room number and location. *
Classroom needs *
Instructor Instructor * First Last
Instructor E# *
Instructor Email *
Faculty type *

Faculty type Unit A - Tenure/Tenure Track Unit B - Annually Contracted Unit B - Academic Support Professional Adjunct
Cell Phone # (if teaching off campus)
Driver's License Number (off campus teaching only)
I certify that I am duly licensed and have in force at least the minimum liability insurance coverage required by the Illinois Vehicle Code.

I certify that I am duly licensed and have in force at least the minimum liability insurance coverage required by the Illinois Vehicle Code. Yes No
Paragraph